How is lactose intolerance managed?

In parts of the world where the local diet contains relatively little lactose, normal lactose intolerance is not considered a condition that requires treatment. However, persons living among populations that are largely lactose-tolerant, with a diet much heavier in lactose (particularly a diet that includes many dairy products), may find lactose intolerance troublesome.

Managing the condition

There is no way to change the production of lactase, but some individuals have reported their intolerance to have decreased over time; this has not been subjected to long-term controlled study, however, and whether it is a case of desensitization remains to be seen. It should be remembered that lactose intolerance is not an all-or-nothing condition: the reduction in lactase production, and hence, amount of lactose that can be tolerated varies from person to person, and may change with age. Since lactose intolerance poses no further threat to a patient's health, managing the condition consists in minimizing the occurrence and severity of symptoms through restriction of lactose consumption.

If a person's diet is already low in lactose, an intolerance to lactose is not an issue. In most of the world, where normal adults are lactose-intolerant, local diets tend not to include foods high in lactose (especially milk products). In other areas of the world, where the local populations still produce lactase in adulthood, this may be reflected in high levels of milk products in the local diet. Lactose intolerance is only a problem for a person who does not tolerate lactose but wishes to consume a diet high in lactose (e.g., a Japanese person living in the Netherlands and wishing to adapt to the local cuisine).

Acclimating the body to dairy products

A study found that people can acclimate themselves to dairy products. Consuming small quantities of dairy products several times a day over a couple of weeks will train bacteria in the large intestine to break down lactose more effectively.

Avoiding lactose-containing products

Since each individual's tolerance to consumed lactose varies, according to the US National Institute of Health, "Dietary control of lactose intolerance depends on people learning through trial and error how much lactose they can handle."

Many people are more tolerant of yoghurt than milk because it contains lactase produced by the bacterial cultures used to make the yoghurt. Also, hard cheeses (e.g. Swiss) produce far less reaction than the equivalent amount of milk because the cheese making and ageing processes greatly reduce the amount of lactose. A typical Swiss or Cheddar might contain 5% of the lactose found in whole milk, while long-aged cheeses contain almost no lactose at all.

Because lactose is also used as a commercial food additive (for its texture, flavor and adhesive qualities), even products that are not apparently dairy—such as sausages (especially hot dogs), margarines, sliced breads, breakfast cereals, chips, dried fruit, processed foods, medications, and meal replacement or protein powders and bars—may nonetheless contain lactose.

As vitamins may be fat or water soluble, lactose is a water soluble molecule which is why it is not present in butter, and is usually present in higher percentages in low fat dairy products. Therefore fat free yoghurts and ice cream have more lactose than regular milk/cream yoghurts and ice creams. Individuals with very low tolerance may experience discomfort from consuming such products.

Kosher foods

Kosher products labeled pareve or meat are, by Jewish law, free of any milk product; dairy residues present in such products may still be of concern to individuals with milk allergies, but are far too negligible to affect even the most severe cases of lactose intolerance.

Alternative products

Reduced or entirely lactose-free products (using milk substitutes, soy milk, almond milk, oat milk, or rice milk) are available allowing lactose-intolerant people to maintain approximately the same diet as those who are tolerant, without having to purchase medication or significantly alter their eating habits.

The food industry has successfully managed to create high quality low-lactose or entirely lactose-free products to replace the regular items. Lactose-free milk can be produced by passing milk over lactase enzyme bound to an inert carrier: once the molecule is cleaved, there are no lactose ill-effects. A form is available with reduced amounts of lactose (typically 30% of normal), and alternatively with almost 0%. Alternatively, a harmless bacterium such as L. acidophilus may be added, which affects the lactose in milk the same way it affects the lactose in yoghurt.

HYLA

Finland has had "HYLA" (acronym for hydrolysed lactose) products available for many years, even though the number of lactose intolerant people there is relatively small. These low-lactose level cow's milk products, ranging from ice cream to cheese, use a Valio patented chromatographic separation method to remove lactose. The ultra-pasteurization process, combined with aseptic packaging ensures a long shelf-life. Recently, the range of low-lactose products available in Finland has been augmented with milk and other dairy products (such as ice cream, butter, and buttermilk) that contain no lactose at all.

The remaining about 20% of lactose in HYLA products is taken care of enzymatically. These typically cost 2–4 times more than equivalent products containing lactose.

Many countries have similar product lines, and new consumer products continue to become available. In America over recent years (1990–2000) there has been a notable increase of available lactose-reduced and lactose-free dairy products; examples being cottage cheese, American cheese and ice cream.

Lactase supplementation

When lactose avoidance is not possible, or on occasions when a person chooses to consume such items, then lactase supplements may be used.

Lactase enzymes similar to the those produced in the small intestines of humans are produced industrially by fungi of the genus aspergillus. The enzyme, β-galactosidase, is available in tablet form in a variety of doses, in many countries without a prescription. It functions well only in high-acid environments, such as that found in the human gut due to the addition of gastric juices from the stomach. Unfortunately, too much acid can destroy it; and it therefore should not be taken on an empty stomach.

On the other hand, the enzyme is ineffective if it does not reach the small intestine by the time the problematic food does; lactose-sensitive individuals must therefore experiment with both timing and dosage to fit their particular need.

Lactase-enzyme medication has an advantage over non-dairy products in that alternative provision does not need to be made for adequate calcium intake, especially in children.